甲状腺thyrotoxicosis2015(医科大版)

Emotional labillity causes patients to lose their temper easily, In rare cases, mental disturbance may be severe; manic-depressive, schizoid, or paranoid reactions may emerge.
• hyperthyroidism
1. Graves’ disease 2. Toxic multinodular goiter 3. toxic adenoma (Plummer disease) 4. iodine-induced hyperthyroidism (IIH) 5. Hashitoxicosis 6. neonatal hyperthyroidism 7. TSH adenoma
• TSAb are demonstrable in the plasma of about 80% of patients with Graves’ disease.
Pathogenesis
• Other antibodies such as antimicrosomal (TMAb) or antithyroglobulin(TGAb) are increased in most Graves’ disease patients.
• Cytokines appear to play a major role in thyroid-associated ophthalmopathy. There is infiltration of the extraocular muscles by activated T cells; the release of cytokines such as IFN40-γ,TNF41, and IL42-1 results in fibroblast activation and increased synthesis of glycosaminoglycans that trap water, thereby, leading to characteristic muscle swelling.
Syndrome caused by the increasment of thyroid hormone
(thyrotoxicosis)
Clinical Findings
Signs and Symptoms Laboratory Diagnosis
• The clinical presentation depends on the severity of thyrotoxicosis, the duration of disease, individual susceptibility to excess thyroid hormone, and patient’s age. In the elderly, features of thyrotoxicosis may be subtle or masked, and patients may present mainly with fatigue and weight loss, leading to apathetic hyperthyroidism.
tissue 6. Ectopic thyroid hormone production( Struma ovarii)
Graves’ disease(GD)
• Epidemiology • Graves’ disease accounts for 80% of thyrotoxicosis,
occurs in up to 20% of women but is one-tenth as frequent in men. The disorder rarely begins before adolescence and typically occurs between 20 and 50 years of age, but it occurs also in the elderly.
Thyrotoxicosis
Qin Ying-fen professor
（一）掌握本病的临床表现，特别是重 要的特征性体征，包括特殊临床表现， 诊断和鉴别诊断。掌握本病药物治疗的
目的和要求 种类、适应证、疗程、副作用及停药原
则，甲状腺危象的临床表现及处理原则。
（二）了解甲状腺激素过多的病理生理 改变。了解本病的病因分类和发病原理。 了解131I治疗和手术治疗的适应证。
• Its pathogenesis involves the formation of autoantibodies that bind to the TSH receptor in thyroid cell membranes and stimulate the gland to hyperfunction.
Nervous System
hyperactivity, nervousness, and irritability, ultimately leading to a sense of easy fatiguability in some patients. Insomnia and impaired concentration are common; apathetic thyrotoxicosis may be mistaken for depression in the elderly.
Hair texture may become fine, and a up to 40% of patients, persisting for months after restoration of euthyroidism.
in sometimes slightly basal body temperature elevated.
1. Syndrome induced by secretion increasement of T3 and T4
2. goiter
3. Manifestations of Orbitopathy
Hypermetabolism Nervous System Cardiovascular System Alimentary System Reproductive Function Muscle and Skeletal System Hematopoietic System
Hypermetabolism
Unexplained weight loss, despite an enhanced appetite, due to the increased metabolic rate.
The skin is usually warm and moist, and the patient may complain of sweating and heat intolerance, particularly during warm weather. Palmar erythema, onycholysis may be evident.
• it is perhaps a kind of disorder of immunologic function induced by infection and various stress factors such as psychic trauma on a background of genetic susceptibility.
autoimmune thyroid Diseases(AITD）：GD、 Graves ophthalmopathy and autoimmune thyroiditis(AIT）
Graves’ disease(GD)
• It has three clinical findings:
Diffuse goiter proptosis
• The major etiologies of thyrotoxicosis are hyperthyroidism caused by Graves’ disease, toxic multinodular goiter and toxic adenomas.
Causes of Thyrotoxicosis
• Thyrotoxicosis without hyperthyroidism
1. Subacute thyroiditis 2. Silent thyroiditis 3. Hashimoto’s thyroiditis 4. Postpartum thyroiditis, PPT 5. Ingestion of excess thyroid hormone (Thyrotoxicosis factitia) or thyroid
Pathogenesis
• Genetic factors, including HLA-DR 、 CTLA-4 polymorphisms, PTPN22、CD40 and enviromental factors contribute to Graves’ disease susceptibility.
Definition
• Thyrotoxicosis is defined as the state of thyroid hormone excess and is not synonymous with hyperthyroidism, which is the results of excessive thyroid function.
IGT or diabetes mellitus.
The oral glucose tolerance curve is often abnormal and varies from one in which the peak glycemia is increased and somewhat delayed to one that is frankly diabetic. Plasma insulin concentrations, however, are increased, suggesting insulin resistance.